OVMC:ED

This is the main page for the Olive View Medical Center Emergency Department

Phone Numbers

• MD Room ED 1A x3648, x3649, x3645, x3709
• MD Room ED 4/5 x4936, x4937, 4938, x4939
• ED 1A: x4320, x4323, x4324
• ED 1B RN: x4865
• ED 2A: x4321
• ED 3: 4976
• ED 4/RME Unit: 4974
• ED 5: 4970
• ICN/Router: x5235, x5236
• Triage 1: x5658
• Triage 2: x5661
• Triage 3: x5662
• Triage 4/RME: x5697

ED Throughput

RME Unit

• Mon- Fri, 8am to 8pm
• ED 4: 34,35,36,37,38,39,40,41
• ED 31/Procedure/Discharge Room will be left open and used for slit lamp exams and ENT procedures as needed, consults and discharge patients home as needed.
• Staffing: two NPs, two RNs, one NA
• Responsible for ESI level 4 and 5 patients
• Responsible for overall turnover of rooms by discharging patients and bringing in new patients to be seen
• NP and RN will pair up and take 4 rooms each, 34-37 and 38-41
• RME Unit rooms will be set up with gurney against the wall and a chair in center of room in which patients will be placed.
• Patients who remain in the ED 4 from the nightshift will either be discharged or moved to another area as soon as is possible for nursing staff. Night shift staff will attempt to move these patients at 6am. Dayshift stay will continue moving patients held over from the night shift.
• In the morning when ED 4/RME Unit rooms are empty, Triage RN will place ESI level 4 or 5 patients directly into empty ED 4/RME Unit rooms; when these rooms are finally full, the responsibility for room turnover will shift to the staff in the RME Unit.
• In the morning, when ED 4/RME Unit beds have been filled by the Triage RN, additional ESI 4 and 5 patients can continue to be placed into other ED beds in ED 1,2,3 or 5 if ESI 1-3 patients do not take precedent.
• NP provider will sign up for the patient in the Res/ML column
• RN will not sign up for the patient on the Tracking Board. The RN, however, will be responsible for patients who are under the care of the NP with which they are paired.
• RN is not required to complete an assessment on every RME Unit patient. If medications given, etc, then a reassessment should be completed. If RME Unit patients are on the track more than 4 hours, a reassessment must be done by the RME Unit RN in the waiting room.
• RME Unit Nursing (RN/NA) responsibilities: visual acuities, drawing blood, obtaining urine samples, sending patients needing plain films to PWR, calling Radiology about patients need utz or CT scan, anticipating procedures such as lac repairs or gyn exams and moving carts to the room, moving patients to and retrieving patients from the waiting room, etc.
• Any patient placed in RME Unit who is subsequently deemed too complicated for RME Unit will have an RME documented, their ESI level changed to 3, orders placed as needed, and patient moved either back to the waiting room or when possible to ED 1, 2, 3, or 5. Responsibility for these patients should also move to the ED provider and nursing staff in those areas. If moved back to the waiting room, responsibility falls back to the Triage and Reassessment RNs.
• Patients requiring plain films will be sent down to PWR/Radiology WR to wait for their imaging. RN or Provider will change the bed assignment to PWR. Radiology tech will then look on the tracking board, find the patient in PWR, complete the plain film imaging and then tell the patient to return to the RME Unit/ED 4 Nursing Station. The RME Unit RNs will then change the bed assignment to TR4 and send patient to waiting room to wait for imaging results.
  • ONLY RME Unit patients requiring plain films will be sent to PWR/Radiology WR.
• Patients who are waiting for laboratory testing results, imaging such as utz or CT, plain film imaging results, or consultations by subspecialits can be moved to the waiting room. Bed assignment will be changed to TR4 in order to keep them visually separate from the other waiting room patients. These patients will remain the responsibility of their providers while they are in the WR awaiting results.
• Patients moved to the waiting room (TR4) or ED 31/Procedure/Discharge Room will not be counted toward the nurse/patient ratios because they will need limited nursing interventions.
• Patients who need to receive discharge instructions will be discharged in their ED room assigned or in ED 31/Procedure/Discharge Room.
• RN will notify housekeeping when a room needs to be cleaned; RN will choose a new ESI level 4 or 5 patient from the WR to fill the room.
• At 7pm the night shift RNs assigned to RME Unit will assume care for the day shift RN’s patients and continue working with the NP per the above guidelines.
• At 8pm, the RME Unit will close, and patients who are still in progress of being cared for by the RME Unit team will be signed out by the day shift NPs to one of the night shift residents. The night shift RNs assigned to EDs 4 continue to care for the patient until discharge.
• At 8pm, ED 4 will be used along with ED 1,2,3 and 5 beds for a variety of patients. Triage RN will be responsible for assigning patients to those beds.
• If the RME Unit is successful, we may extend hours to 8pm-8am when a night shift Nurse Practitioner has been hired. We may also extend the RME Unit, as needed, to include additional ED beds and other ED nursing and provider staff.

Admission Guidelines

• Tele Guidelines
• Surgical Subspecialty Guidelines

Follow Up Guidelines

OOP (Out of Plan)

• Orange OOP on Tracking Board indicates out of plan insurance. Patient should be referred back to their health plan and PCP. Info on health plan and PCP found on Patient Summary (Discharge Instructions), Demographics and Utilization Review tabs.
• Do not refer OOP patients to subspecialty care at OVMC
• OOP Health Plan and/or clinic name will print automatically on the Patient Summary (Discharge Instructions).

DHS Empaneled

• To find out if a patient is empaneled to DHS, look at the banner bar on the patient chart. Look right hand side "Emp Prov". Name of PCP will be written there.
• If empaneled, clinic name can be found listed under Additional Patient Information on ED Summary page.

MHLA (My Health LA)

• Not an insurance plan but gives patient access to primary care clinic and PCP
• MHLA patients receive all specialty care at OVMC or other DHS facilities
• OK to refer MHLA patients to subspecialty care at OVMC

NERF (New Empanelment Referral Form)

• Used to enroll patients with significant PMH who have no primary care or health plan
• Patient must have at least one of the following diagnoses (see attached list)
• Only about 1/3 of patients will actually receive a PCP through the NERF process. Because of that, give patient a clinic list upon discharge so he/she can find a PMD on their own.
• To enroll in NERF program, click NERF while completing Depart process. Check off diagnoses that apply. Click green arrow. Clerk will complete on-line NERF form.

TFU (Telephone Follow Up)

• Used for follow-up of culture or GC/chlamydia results
• To refer to TFU, click ED Post Visit Plan while completing Depart process, choose ED-TFU-OVM and indicate what needs to be followed up
• Ensure we have a correct phone number on the patient
• If patient has already been discharged from the ED and you want to refer to TFU
  • Step 1: Find patient on the Look Up track (only good for 7 days after discharge)
  • Step 2: Choose patient on the Look Up track, click Modify Events.....Request Event......Post Visit ED TFU
  • Step 3: Open patient's chart......Depart.....now fill out ED Post Visit Plan form
  • If you do not follow these steps, TFU will not be flagged to follow-up the patient

CCC (Continuing Care Clinic)

• ED Followup Clinic used for complicated patients without primary care or an outside health plan
• To refer to CCC, click ED Post Visit Plan while completing Depart process, choose ED-CCC-OVM and indicate why patient needs CCC Follow-up
• Guidelines for CCC:

Urgent Referrals for Subspecialty Care/Message Pools

• Used to refer patients to certain subspecialty clinics for urgent follow-up appts (<2 weeks)
• Do NOT refer OOP patients or non-urgent complaints through the Message Pool
• For ENT and Ophtho patients, page the on-call resident for approval for the urgent follow-up appt. Type in the approving resident's name and the follow-up date/time agreed upon. Tell patient to show up at 10am to the clinic.

Econsult

• Used to refer patients to subspecialty clinics for non-urgent follow-up appts. Not all referrals are approved. If approved, appts are likely months away.
• Do NOT refer the following:
  • GI - diverticulitis, undiagnosed abdominal pain, gastritis without minimum of 3 months of PPI or h.pylori treatment
  • Neuro - simple seizures, headaches

Neurology

Matt's Reminders

• Please call neurology for ANY questions regarding the management of stroke patients
• All CVAs with symptoms within 8 hours should be discussed with neurology
• For acute CVAs within a 5 hour window the imaging of choice is CT angiography head with and without contrast
• Admit TIAs to medicine: we don’t send them home
• E-mail Matt with any difficult neurosurgery transfers or neurology issues. Matt's cell is posted in ED. Matt has direct contact with USC Neurosurg and is appy to help in the heat of battle

Psychiatry

• x4340
• For patients without medical complaints, medically screen patients at Triage or Ambulance Triage. If medically cleared, provider should call x4340 and speak to Psychiatry MD who should approve patient being sent over to the Psych ED
• If patient is placed into an ED bed and needs emergent psychiatry, order Consult to Psychiatry and call x4340 to speak to Psychiatry MD.

Radiology

On Call Schedule

• Operator has Radiology on-call schedule and pager numbers
• Also posted on OVMC Website...Departments....Radiology....On-Call Schedules....Radiology Faculty Schedule Current Month

USC Coverage for OVMC ED

• Mon-Fri 11pm-7am
• Sat/Sun and Holidays 7pm-7am
• 323-409-6679

Interventional Radiology After Hours

• Intervential Radiology Available After Hours (Operator has Interventional Radiology on-call schedule)
  • Percutaneous abscess drainage
  • Image-guided paracentesis
  • Image-guided thoracentesis
  • Percutaneous cholecystostomy
  • Percutaneous nephrostomy/nephroureteral stent placement and other urologic intervention as applicable
  • Transhepatic biliary drainage and other biliary intervention as applicable
  • Central venous access including placement of tunneled/non-tunneled catheter
  • IVC filter placement
  • Transarterial embolization for unremitting hemorrhage refractory to conventional therapy
  • IR Consultation
• Interventional Radiology NOT Available After Hours (Only available Mon-Fri 8am-5pm)
  • No MSK procedures (e.g. no joint aspirations)
  • No LPs
  • No G/GJ tube replacement (if tube fell out, place foley temporarily)

MRI After Hours

• MRI tech is in-house Mon-Fri 7am to midnight. All other hours are considered off-hours.
• MRI tech is on-call for emergent cases limited to acute cord compression and rarely acute CVAs if requested by the Neuro Service for patient management (e.g. large CVA that may be considered for transfer to UCLA for intracerebral angio therapy)
• Findings that suggest acute cord compression include:
  • 1. Bladder dysfunction (urinary retention or incontinence)
  • 2. Bilateral limb weakness
  • 3. Sensory abnormalities with a sensory level
  • 4. Flaccid areflexia with upgoing toes, loss of anal sphincter tone
• Some cases may be able to wait until the morning hours such as IVDA, fever and back pain without neuro findings.
• To request an emergent MRI when the tech is not here, first contact the STAT Radiologist in-house Mon-Fri until 11pm and weekends/holidays until 7pm. If there is no STAT Radiologist in-house (e.g. after 11pm), contact the Neuro Radiologist on standby (on-call).
  • On-call schedule can be found on OVMC Intranet...Departments...Radiology...Radiology Faculty Schedule Current Month.....Neuro/MRI Standby. Operator has on-call schedule also and pager #s.
• ED MD pages the Neuro Radiologist on standby (on-call) and requests MRI.
• STAT Radiologist or Neuro Radiology Attending then pages the MRI tech.
• For cord compression cases, as much as possible, try to narrow down the level where the possible pathology lies e.g. lumbar vs thoracic. If this is not possible, a "cord compression" MRI protocol can be performed that will give a large field of view (sagittal images) that will cover the whole spine in two slabs (cervical through mid-thoracic and mid-thoracic through lumbar), along with axial T2 images through the whole spine. Will not give great detail, but will see gross cord compression or high grade lumbar spinal canal stenosis. Decision about what imaging is performed will be up to the Neuro radiologist on-call.

RME Unit

• Open Mon-Sun 8am - 8pm
• ED 4: beds 34,35,36,37,38,39,40,41 (31 to remain open for eye/ent exams or discharging patients as needed)
• Staffed by 2 NPs and 2 RNs
• Primarily for ESI 4s and 5s
• Gurney to be placed to side of room with chairs available for patients. Patients to be placed into chairs whenever possible

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Social Work

Contacting Social Worker

• Place order for SW under Consult - No Auto Paging OVMC
• Monday – Friday 8am – 4:30pm
  • 1. Pager 818-320-8499 or x5479 (Erica)
  • 2. If no answer, try x 4294 or x4295 Supervisors’ lines
  • 3. If no answer, try x4236
• After hours, 4:30pm – 8am or weekends or holidays, “crisis only” pager, 818-313-1637

Transfers

Higher Level of Care Transfers

• Neurosurgery
• Pediatrics
  • Patients followed by UCLA Pediatric subspecialties at OVMC may be transferred to UCLA if accepted by UCLA Pediatrics or subspecialist.
  • OVMC Pediatric resident will contact UCLA inpatient staff or subspecialty service about transfer
  • Once accepted, transportation will depend upon the type of transfer: PICU transfers will be transported by the UCLA Transport team; Ward transfers will need to have transportation arranged by OVMC ED UR staff.
  • For all other pediatric patients who require a higher level of care transfer, if insured, all attempts should be made to transfer the child to their health plan/PCP; For uninsured patients, transfer to USC or Harbor through the MAC should be arranged.

Utilization Review

• x4890

Pharmacy

===ED Pharmacist Mon-Fri 8am-4pm x5490

Supplies and Equipment

Orthopedic supplies

• Located in Room 43
  • Soft collars, slings, wrist guards, CAM walkers

Crutches, Walkers, Wheelchairs

• Located in ED1A MD Room

Bronchoscope

• Located in storage room near Triage 4. Disposable scopes in cabinet in same room.

Forms

Link for forms

• Blood Transfusion Consent English
• Blood Transfusion Consent Spanish
• DMV Request for Reexamination
• Public Health - Animal Bite Reporting Form
• Public Health - Confidential Morbidity Report
• Public Health - STD Confidentiality Morbidity Report
• TB Patient Info Form English
• TB Patient Info Form Spanish
• Transfer Patient Consent
• Transfer Interfacility Transport Form

Downtime Protocols

• ED1A Clerk has all downtime forms

Links

• OVMC Ultrasound
• UCLA/OVMC Emergency Medicine Residency
• Pain-EM